Institute of Facial Surgery St Paul, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D6950 Issued in MN

Legal business name

INSTITUTE OF FACIAL SURGERY ST PAUL, PLLC

Practice address

1774 Cope Ave E
Suite 140
Maplewood, MN 55109-2662

Phone

(651) 774-9611

Fax

(651) 748-3704

NPI assigned

May 14, 2010

Last updated

Apr 21, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jerry Kent Brunsoman, D.D.S.

Title

President

Phone

(651) 774-9611

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Keith Schulte, DDS,MSD

  • Prosthodontics
  • Maplewood, MN
  • NPI 1003830712
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303344000000",
    "number": "1477871457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1774 COPE AVE E",
            "address_2": "SUITE 140",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551092662",
            "telephone_number": "651-774-9611",
            "fax_number": "651-748-3704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1774 COPE AVE E",
            "address_2": "SUITE 140",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551092662",
            "telephone_number": "651-774-9611",
            "fax_number": "651-748-3704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE OF FACIAL SURGERY ST PAUL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-14",
        "last_updated": "2011-04-21",
        "status": "A",
        "authorized_official_last_name": "BRUNSOMAN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-774-9611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "D6950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Hystead
• Margaret Kay Iaizzo, PT
• Qali Mohamed Ibrahim
• Richard Chima Ikeri Sr.
• Institute of Facial Surgery St Paul
• Interactive Therapy Services, Inc. (Functional Kids)
• Nadeem Iqbal, M.D.
• Isd 622 Gladstone Meals on Wheels
• Alexander Ivaskovic, MD
• Kathleen Ann Iverson, LDH

• Dental Clinic/Center in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.